Don’t call electroconvulsive therapy ‘shock therapy’

ByKate G. FarberandCharles H. Kellner

May 20, 2016

An electroconvulsive therapy machine is seen in a treatment room in the ECT Clinic at McLean Hospital in Belmont, Mass.Kayana Szymczak for STAT

The STAT headline blares “Psychiatric shock treatment, long controversial, may face fresh restrictions.” But there isn’t a hint of controversy inside the electroconvulsive therapy (ECT) service where we work. The schedule is already overbooked and new appointments are made every day. Our grateful patients bring gifts of chocolate and wine for the nurses and doctors and send holiday greeting cards. ECT isn’t fringe science — it helps hundreds of thousands of people overcome severe depression every year and saves many from suicide.

Contrary to its presentation in the media, ECT isn’t medically or clinically controversial. Experts recognize its importance as a life-saving measure for individuals with severe psychiatric illnesses such as depression, bipolar disorder, schizophrenia, and catatonia. Thousands of studies conducted over the past 50 years have demonstrated ECT’s safety and effectiveness.

So where does the “controversy” come from? Mainly from a combination of outdated information and popular culture.

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Years ago, ECT was done with no anesthesia, which gave rise to its depiction in movies like “One Flew Over the Cuckoo’s Nest.” Even though ECT has changed radically since then, it is still rarely depicted accurately today.

Modern ECT is performed under full general anesthesia and muscle relaxation. The patient sleeps right through it. At our ECT service, patients can let their friends and family watch the treatment. Observers are typically surprised by how benign the procedure is. “That’s all it is?” they ask, when we tell them the patient will be awake again in just a few minutes.

Inaccurate portrayals of ECT aren’t a thing of the past. In the upcoming DC Comics movie “Suicide Squad,” for example, a character is shown using an ECT device to torture a woman into insanity.

Although journalists usually present this therapy in a more factual light than Hollywood does, they aren’t immune from the temptation to sensationalize. One way they do this is by using the outmoded, melodramatic term “shock therapy.” Another way is by misconstruing scientific research. A recent news article from STAT about ECT, for example, cited a Scottish study as evidence of ECT’s potential for harm. According to the article, the study showed that ECT may “interfere with the connections that underlie the brain’s complex circuitry.” The study itself, however, said nothing about harm. It did demonstrate, though, that ECT affects brain connectivity and this may be beneficial, rather than harmful.

All too often, journalists uncritically present two opposing sides of an issue to give the illusion of balance. ECT is seldom reported on without the story including claims of extreme memory loss or brain damage. Severe memory loss is a rare side effect, while claims of brain damage are unfounded.

ECT seems to get this treatment more often than other therapies do. Coronary artery stents are widely used to treat heart disease, even though they also increase the risk of blood clots and stroke. But reporters don’t give equal weight to arguments that stents are too dangerous to use and should be banned because a small percentage of patients have bad outcomes, including death.

Not all inaccurate portrayals of ECT are the result of simple factual ignorance. The Church of Scientology and its Citizens Commission on Human Rights have spent decades waging a deliberate smear campaign against ECT, and against psychiatry as a whole. The Citizens Commission website denounces “shock therapy” as torture and provides links to sites that promote “alternative therapies” instead, such as treating psychosis with vitamin supplements. It may seem easy to mock an organization that runs the colorfully named “Psychiatry: An Industry of Death” museum in California, but the group has deep pockets and a wide reach.

We need to stop sensationalizing ECT. By continuing to do so and fueling the “controversy,” we’re risking people’s mental health, and even their lives.

ECT isn’t perfect. Like any medical procedure, it carries risks and potential side effects that should be discussed honestly and openly. Its benefits should also be discussed that way.

Finally, please don’t call ECT “shock therapy.” It may be a catchy term, but it perpetuates people’s false impressions. Treat ECT like you would any other medical procedure and call it by its proper name.

Kate G. Farber is a volunteer in the Department of Psychiatry and Charles H. Kellner, MD, is professor of psychiatry and director of the ECT service at the Icahn School of Medicine at Mount Sinai.

Well I have researched ECT deeply and for a long time. Here’s the truth. Psychiatrists and the Mental Health system make bank off this BS torture. They’ve actually convinced some people – not everyone – that this is safe and effective, when there’s NEVER been a clinical trial that proves it. It should be looked at as exactly what it is – electricity zapped thru the brain causing a grand mal siezure which does cause lasting adverse effects. How much does it cost? Up to $2500 per session (and treatments are usually multiple, sometimes 5-12 sessions per treatment). How much $ in electricity is used? Let’s put it this way, I couldn’t buy a coffee with how much it actually costs. Don’t let any shrink or system fool you, this is dangerous. Yes indeed, call it Shock Therapy (even though it isn’t therapy, if you look up the word you’ll see what I mean.

I had the pleasure of working with the author, Kate Farber, and Dr. Kellner. ECT has absolutely saved my life. It makes perfect sense to me that different people would have different experiences … but for someone like me who flat out cannot tolerate psychiatric medication and was eventually diagnosed with Treatment Resistant Depression, ECT has been a lifesaver. I continue on a course of maintenance ECT about once a month with the goal of stretching out those intervals. I just would hate for people to read all the negativity below and not hear from someone whose life had been rebuilt because of ECT. I have only known Dr. Kellner to be kind, gentle and respectful. I believe very strongly in the efficacy of this treatment. Some memory problems but it has been worth it. Furthermore, for those of you who say the media doesn’t cover the negatives??? Wow, that is ALL I ever see!!!! I am CONSTANTLY explaining to people that this is not like “Cuckoos Nest.” My advice to anyone considering this treatment? Meet with someone like Dr. Kellner (or him if you live in the NYC area), discuss the risks and benefits. I would be dead without ECT.

Well, Anonymous, sadly this is the internet, where every datum and opinion must come under scrutiny if we are to believe it.
In some other forum, or meeting you in person, we could understand what you mean by “saved my life” despite “some memory problems.”

But I have met people who said “psychiatry made me well.” They spoke in a lost, robotic, zombie voice and as they were speaking, globules of drool ran from their mouth down their chest. They could barely stand up straight or even do simple tasks. One, I remember well, used to be a chemistry PhD expert.
Yet “psychiatry made them well.”